Method for electrosurgical severance of adhesions



5F. c. WAPPLER 'ET AL METHOD FOR ELECTROSURGICAL SEYERANCE OF ADHESIONS original Filed Nov. .18, '1932 s sheets-sheet 1 Jln- 26, 193?, F. c. WAPPLER ET AL 2,068,721

METHOD FOR ELECTROSRGICAL SEVERANCE OF ADHESIONS 'Original Filed Nov. 18, 1932 5 Sheets-Sheet 2 Jan 25, 1937 F. c. WAPPLER ET A1. 2,068,721

METHOD FOR- ELECTROSURGICAL SEVERANCE OF 'ADHESIONSI Original Filed Nov. 18, 19Z` 2- 3 Sheets-Shea?I 3 Patented Jan. 26, 1937 i stares PATENT OFFICE METHOD FOR ELECTROSURGICAL SEVERANCE F ADHESIONS Frederick Charles Wappler, New York, N. Y., and

Reinhold H. Wappler, deceased, late of Yonkers, N. Y., by Frederick Charles Wappler, administrator, New York, N. Y.

3 Claims.

Our present invention relates generally to the surgical art, and has particular reference to an improved method for severing adhesions.

This application is a division of our copending 5 application Serial Number 643,150, led November 18, 1932; now Patent No. 2,031,682, patented Feb. 25, 1936, and it is also a continuation in part of our copending application Serial Number 643,846, filed November 22, 1932.

It is a general object of our invention to provide an improved electrosurgical method for eifecting an eiicient severance of adhesions; more particularly, a method which employs the cutting and/or coagulating capabilities of modern high-frequency electric current.

The primary purpose for which our present method is devised, although obviously our invention is from certain aspects not restricted to any specic application, lies in the cutting through g@ of adhesion bands in the pleural cavity, the presence of such bands being highly undesirable, as is well known in the surgical art, for the reason, among others, that normal and complete respiration is impeded thereby; and in many cases cong5 valescence from pleural or pneumonie ailments is prevented.

The severance of an adhesion band in the pleural cavity is particularly dangerous because of the serious consequences resulting from unchecked hemorrhage. The modern technique of electrosurgery, employing the characteristics of high-frequency cutting and/or coagulating currents, suggests the possibility of harnessing this technique to the present objective. But it has been found to be unsatisfactory, in many respects, merely tovinsert a cutting electrode and to cut through an adhesion with it. In the rst place, the procedure may not feasibly be carried out under water, and the generation of fumes, which 4o impede visibility, is therefore a problem that must be reckoned with. In the second place, and of greater significance, is the fact that most adhesions are in a stretched or tensioned condition when the lung is collapsed to eiect pneumothorax. Cutting through a tensioned element of this character is precarious because of the danger that the band will tear or divide prematurely, with the result that stumps which have not been r rendered fully hemostatic may render the attempted operation fatal to the patient.

It is a general object of our invention to provide an improved method whereby an unhurried and thoroughly controllable operation may be performed, under continued and assured illumi- Cil (Cl. 12S-303.15)

nated vision, and with minimum danger from the standpoint of hemorrhage.

Briefly, our present method involves the step or steps of preliminarily engaging or clamping the adhesion irmly at or adjacent to the area at which it is to be cut, and maintaining this engagement until the operation of severance has been completed. Preferably, the adhesion is grasped or clamped at two spaced areas on opposite sides of the area to be out, and our present procedure provides for cutting through the adhesion without releasing such engagement, whereby the resultant stumps may be thoroughly examined and treated, if necessary, all in an un hurried manner, before they are nally released.

Our invention also preferably provides for preliminarily coagulating the area at and adjacent to the line along which the adhesion is to be out, our preferred mode of procedure thus involving the successive steps of clamping the adhesion, coagulating the desired area, cutting through the coagulated area, and finally releasing the resultant stumps. Preferably, the coagulation is produced by current that is directed to the area by the clamping means itself.

The present method is preferably, but not necessarly, carried out by means of a unitary instrument which is provided in an eicient and compact manner with a clamping means, a cutting electrode, a telescopic means, an illuminating means, suitable electric binding terminals for establishing desired connections for the respective currents which are required, means for eficiently insulating the cutting electrode from the other portions of the instrument, mechanisms for controlling the movements and operations of the several parts in a simple and reliable manner, and means for withdrawing from the area of operation such fumes as may be generated in the vicinity of the telescope objective. An instrument of the preferred type may be inserted into the pleural cavity through only a single opening provided for this purpose.

We achieve the foregoing objects, and such other objects as may hereinafter appear or be pointed out, in the manner illustratively exemplified in the accompanying drawings, wherein- Figure 1 is a side view of an' instrument capable of use in carrying out the steps of our present invention, a portion being broken away for the sake of compactness;

Figure 2 is a top view of the operative portions of the device of Figure 1;

Figure 3 is an enlarged fragmentary View taken substantially along the line 3--3 of Figure 1;

Figure 4 is an enlarged fragmentary View taken substantially along the line l-l of Figurer 2;

Figure 5 is an enlarged cross-sectional View taken substantially along the line 5 5 of Figure l, with certain elements omitted for the sake of clearness;

Figure 6 is a View similar to Figure 1, showing a modified type of instrument by means of which the present method may be practiced;

Figure '7 is a View similar to Figure 2, showing the operative parts of the instrument of Figure 6;

Figure Sis an enlarged fragmentary View taken in the same direction as Figure 6;

Figure 9 is a cross-sectional view taken substantially along the line 9 9 of Figure 8;

Figure 10 is an enlarged fragmentary View taken from the bottom, i. e., substantially in the direction lt-l of Figure 6;

Figure l1 is an enlarged perspective view of the operative members of the instrument of Figures 1-5, illustrating its mode of use;

Figures 12, 13, and 14 are diagrammatic plan views illustrating the present mode of procedure;

Figure 15 is a view similar to Figure 11, showing the mode of operation of the instrument of Figures 6-10;

Figure 16 is a View similar to Figure 15, illustrating a further step in the present method;

Figure 17 is a View similar to Figure 11, diagrammatically illustrating a possible modification;

Figure 1s is a View similar to Figure 1'7, illustrating a possible further modification; and

Figure 19 is a view similar to Figure 17, illustrating a possible further modification.

The instrument of Figure 1 embodies the usual endoscopic tube or sheath 39, provided with the obliquely lateral fenestra 3l at the forward end, and terminating at the rear end in the collar 32 and the connection neck S3. The latter is preferably provided with a ridge or block 34 and a clamping means 35, by means of which the operative insertable portions of the instrument may be secured to the sheath 39. The neck 33 is also provided With the irrigation outlet 35 which communicates with the interior of the tube 39.

The operative insert member includes the usual connection plug 3l, which carries the forwardly extending fork 38 and pin 39 for cooperation with the block 35 and clamping means 35. The plug 3l preferably carries the electric binding post 49 which need not be insulated and which establishes an electrical connection with all the metallic parts of the instrument and all parts not specically insulated therefrom. This binding post is adapted to be connected to any suitable source of high-frequency current, as will be explained more fully hereinafter.

In the illustrated instrument, a rearwardly extending support il is rigidly secured to the plug 3l and terminates in a bearing 2.2 provided with the clamp 53, by means of which the rear end of a suitable telescope ill may be supported. This telescope is preferably of the character illustrated in United States Letters Patent No. 1,680,491, and consists of an eyep-iece 55, the electric terminal rings (for establishing suitable connection with the illuminating lamp), the forward objective il (which commands a forwardly oblique field of vision), and the illuminating lamp 48 mounted upon an attenuated tip.

Carried by the plug 3l is a forwardly extending, elongated stem 59 (Figure 5) which carries an upwardly projecting guiding tube or channel 50, a downwardly extending guiding tube or channel 5|, and lateral guiding tubes 52. The channel 50 snugly yet slidably supports and engages the body of the telescope 44, it being understood that the plug 3l is provided with a suitable bore through which this telescope slidably yet snugly extends.

Carried at the forward end of the stem 9 is the rigid and immovable clamping jaw 53 which is substantially U-shaped, as illustrated most clearly in Figures 2 and 11, and which is preferably provided with teeth 54. The axis of the U, it will be observed, lies substantially in alignment with the axis of the stem 49..

A complementary jaw 55 is pivotally associated with the jaw 54 at the rear points 56, it being understood that the jaw 55 is similarly U- shaped, and that the reference numeral 56 is intended to apply to both points of pivotal connection, there being a pivot point of this character in association with each pair of adjacent arms of the U-shaped jaws. The jaw 55 is preferably provided with teeth 5l, and it is so mounted in association with the fixed jaw 53 that when a member, such as the adhesion band 58 of Figure 1l, is positioned between the jaws, the two jaws will lie substantially parallel to each other.

The movable jaw 55 is adapted to be swung between the full-line position and the dot-anddash line position of Figures 1 and 4 by means of a control mechanism which may, for example, consist of two rearwardly extending control rods 59, extending rearwardly through the guide tubes 52. rEhe forward end of each guide rod 59 is pivotally connected, as at 59, to th-e corresponding arm of the jaw 55, so that axial reoiprocation of the rods 59 will pivot the jaw 55 around the pivots 55 and thereby move it in the manner hereinbefore referred to and clearly illustrated in Figures 1 and 4.

The rods 59 are preferably controlled by a scissors-like control member 6I mounted at the rear end of the instrument, one of the handles being rigidly secured, as at 62, to the bottom oi the plug Sl, and the other handle being pivotally mounted, as at 63, to the xed handle, so as to be movable into and out of the full-line and dotand-dash line positions of Figure 1. The free end of the movable handle is forked, as at B4, and each prong of this fork engages with one of the rods 59, as, for example, by means of set screws 55, as illustrated most clearly in Figure 3.

From the description given, it will be obvious Vthat by bringing the handles of the mechanism 5l toward each other, the jaws 53 and 55 will be moved into closed relationship; and by spreading the handles, the rods 59 will be retracted and will thereby accomplish an opening of the jaws.

The cutting electrode of the instrument illustrated in Figures 1-5 consists of an attenuated electrode wire 56 whose forward free end is arranged along a substantially transverse direction and is positioned within the space between the opposite longitudinal sides of the jaws. This wire emanates from the forward end of a sheath of insulation Bl which is, in turn, mounted in a metallic sheath 53. The body of the wire 66 extends rearwardly for the full length of the instrument, and it is ensheathed in the insulation 5l and the sheath 68 throughout its entire length. This assembly is mounted for axial reciprocation within the guide tube or channel 5I, as shown most clearly in Figure 5.

At the rear end, the sheath 55 passes through a suitably prepared bore in the plug 3l, thence through the space provided by the two prongs of the forked end 64, and thence into nal association with a rear terminal block B9 provided with the control handle 1U. This block carries the electric binding post 1|, and the interior assembly has not been illustrated although it will be understood that, in any suitable or convenient manner, the interior conductive terminal portion of the post 'Il is connected electrically with the rear end of the wire 65. The post 1| is preferably of insulating material, as is the major portion of the block 69 with which it is connected, and it will be understood that although all other metallic portions of the instrument are arranged and assembled in mutually uninsulated relationship, and in electrical connection with the binding post 4I), the wire 65 is mounted in an insulated relationship by means of the insulation sheath 6l and the electrical association of parts at the rear block 59 and the post 'I I.

The block 69 carries the upwardly extending pin l2 which is slidably positioned within a longitudinal slot 'I3 provided for this purpose in the supporting arm 4i; and by manipulating the handle the cutting electrode assembly may be reoiprocated axially within the limits dei-ined by the ends of the slot 13. The effect of this movement upon the operative forward end of the wire 66 is to reciprocate the latter between the full-line position of Figure 4 and the dot-anddash-line position. This movement, it will be noted, is along an axial direction, and within the confines of the space bounded by the opposite longitudinal side portions of the jaws 53 and 55.

The block 69 is provided with a suitable bore to permit passage therethrough of the telescope 44, and this engagement is sufficiently loose to permit the block 69 to be slid back and forth in the manner described.

The salient features of the present method are illustrated most clearly in Figures 11-14. Where the method is carried out with the aid of the instrument hereinbefore described, the instrument is inserted through a suitable opening in the pleura, and the adhesion to be severed is engaged by the jaws 53 and 55 in substantially the manner illustrated in Figures 11, 12, and 13. This engagement is effected adjacent to the area at which the severance is to be effected. A suitable coagulating current is then conducted to the jaws 53 and 55 and caused to pass into and through the adhesion 58 so as to coagulate the latter at and between the areas of engagement. This passage of current may be effected in a variety of ways, the preferred mode being to connect the patient with a suitable indierent electrode (not illustrated). An electrical connection is made between this indifferent electrode and one terminal of a suitable source of coagulating current. An electrical connection is then established between the other terminal of such current source and the binding post 40, thereby establishing an electrical connection between the lastmentioned terminal of the current source and both jaws 53 and 55. These jaws thus serve as coagulating electrodes, and the passage of current through the adhesion and through the patients body to the indifferent electrode will cause coagulation to take place at and adjacent to the areas of engagement of the jaws 53 and 55.

During this procedure, the cutting electrode B6 is in its retracted position. When the area to be cut is satisfactorily coagulated, especially the area lying between the spaced areas of engagement of the opposite longitudinal sides of the jaws, a suitable cutting current is caused to pass through the electrode 66. This may also be accomplished in a variety of ways, preferably by maintaining the indifferent electrode connection with the patients body, and by establishing an 5 electrical connection between the opposite terminal of a suitable source of cutting current and l the binding post ll. The connections with respect to the coagulating procedure will in the meantime have been disconnected, or, at least, rendered inoperative. The cutting electrode 66 is then advanced, as indicated in Figures 1l and 12, with the result that the electrode wire 65 will cut a path through the coagulated clamped area of the adhesion 58.

It is to be noted that this cutting procedure is accomplished without releasing the engagement of the adhesion 58, and that, because of this mode of procedure, the opposite resultant stumps do not of themselves snap back out of the range of vision and operation. Quite to the contrary, the opposed stumps are maintained in clamped relationship, as indicated in Figure 13, an-d it is therefore within the control of the surgeon immediately to detect and to remedy any deficiencies in establishing a complete and thorough hemostasis.

After the surgeon is satisfied that the procedure has been satsfactorily accomplished, and that both opposite stumps are hemostatic and in proper condition for release, the clamping jaws are released, and the instrument withdrawn, The resultant stumps are illustrated in Figure 14, and the shaded areas in Figures 12-14 illustrate areas which have been subject to coagulation.

During the foregoing procedure, the irrigation outlet 35 is employed as an aspirating conduit, whereby any fumes which would otherwise impede visibility are constantly capable of being drawn outwardly through'the tube 39.

It is further to be noted that the foregoing procedure may be accomplished, in its entirety, under maintained illuminated visibility, the jaws and electrode of the preferred instrument being so mounted, constructed, and arranged that a full and unimpeded field of illuminated vision is constantly maintained, this field of vision encompassing the entire clamped area of the adhesion. The eifect of the coagulating procedure may thus be carefully and continuously observed, and the movements and effect of the cutting electrode are similarly under constant, clear, and unimpeded illuminated vision.

The instrument illustrated in Figures 6-10 is of a slightly modified character and may be employed in carrying out a slightly modied form of the present method, wherein the adhesion is engaged at only one area, instead of at two spaced areas. In employing the instrument of Figures 6-10, only one of the resultant stumps is maintained in engagement during and after the cutting procedure; and while, from many aspects, the method, as carried out by the instrument of Figures 1-5 is obviously preferable, there are many instances in which the modified method, carried out by the instriunent of Figures 6-10, may be used to advantage, despite the fact that only one stump is ultimately held in engagement. For example, where the cut is to be effected close to one end of an adhesion, the modified method may be preferable.

It will be understood that the usual endoscopic sheath or tube is provided, although it has not been illustrated in Figures 6-10, and that the plug 8B, the fork 8i, and the pin 82 are provided 75 on the instrument illustrated for the reasons hereinbefore assigned.

The plug is similarly provided with the rearwardly extending support 83 terminating in the bearing 85 which engages the rear end of the telescope 85. The terminal block forthe rear end of the active cutting electrode is in this case designated by the reference numeral 86 and is rigidly secured to the support 83, as by means of the stud 81.

The scissors-like control mechanism 88 is also provided, with one handle being secured, as at 89, to the plug B6, and the other handle being pivoted, as at 90, so as to be movable between the full-line an-d the dot-and-dash line positions indicated in Figure 6. The free end of the movable handle is not forked, but is pivotally connected, as at 9|, to the rear end of a single control rod 92 which actuates the movable jaw.

Extending forwardly from the plug 80 is the elongated stem 93 which carries the laterally disposed guide channel or tube 9d, and the opposite guide channel or tubes S5 and 0S. The channel 9A snugly yet slidably accommodates the telescope 85 which is preferably, as before, of the general character which commands a forwardly oblique field of vision. The telescope is laterally mounted, in this case, however, so that the axis of its field of vision is directed toward the left in Figure 9, and so that the operator will command a view of the several operative parts in substantially the same manner as the reader is viewing Figures 6 and 8.

Secured to the forward end of the stem 83 is the rigid or immovable jaw 97, and pivoted to the rear end of this jaw, as at 98, is the complementary movable jaw 9S. The movements of this jaw are controlled by the rod 92. which extends forwardly through the guide tube 85 and which is pivotally connected at its forward end, as at |00, to the movable jaw 8E. The reciprocation of the rod 82, by manipulations of the mechanism 88, cause the movable jaw 99 to move between the closed full-line position of Figures 6 and 8 and the open dot-and-dash line position of these figures.

The binding post |0| is mounted upon the plug 80, and need not necessarily be insulated, estabnishing an electrical connection with all the metallic portions of the instrument not specically insulated therefrom. This binding post may thus serve, as hereinbefore described, to establish an electrical connection between a suitable source of coagulating current and both jaws 9i and 89.

The cutting electrode is in this case composed of an electrode wire |02 which is mounted for pivotal movement between the full-line position of Figures 6 and 8 and the dot-and-dash-line position of these iigures. This movement is accomplished by constructing the wire |02 with a bellcrank rear end, pivoted, as at |03, to the insulating support |04 which is rigidly secured to the fixed jaw 97 by means of the clamp or tab |05. The free rear end of the bellcrank member is pivotally connected, as at |06, to the forward end of a control wire |0'l which extends rearward-A ly into and through the insulating guide tube |08. The tube |08 is ensheathed in a metallic sheath |09, and the tubes |08 and |09 extend rearwardly for the full length of the instrument and terminate in the interior of the terminal block 86. The sheaths |08 and E09 are immovable, but the wire |01 is axially movable and is connected at its rear end to the interior conductive portion of the electric binding post H0. This binding post is rotatably mounted Within the block 86 in axial association with the rotatable control handle The latter is adapted to be swung between the full-line and the dot-and-dash line positions of Figure 6, and is connected to the wire |07 in such a manner (not illustrated) that these movements will reciprocate the wire |07 axially.

The specific construction and arrangement of the terminal block 86 and its associated parts has not been illustrated since it has no material direct bearing upon the features of our present invention, and since any suitable mechanism of the general character indicated will suffice. It is to be noted, however, that the binding post H0 and the major portion of the block 88 are of insulating material, so that an insulated electrical connection may be established between the interior of the binding post I0 and the electrode wire |02. Also, the movements of the control handle ||0, regardless of its exact construction and arrangement, are adapted to effect a r-eciprocal axial movement of the control wire |01. By advancing this wire the electrode member |02 is swung into the full-line position; and by retracting the wire |01 (by swinging the handle into the dot-and-dash position), the electrode member |02 pivots around the pivot |03 into the dot-and-dash position.

In the construction illustrated, the insulating support |015 is shown as an integral continuation of the insulating sheath |08 through which the control wire |01 extends, but it will be understood that this-construction is not essential.

The carrying out of the present method by means of the instrument of Figures 6-10 is illustrated most clearly in Figures l5-16. The adhesion i l2 which is -to be cut is first engaged by the jaws 9i' and 89 in substantially the manner illustrated in Figure 15, adjacent to the area through which the severance is to be effected. During this procedure, the cutting electrode |02 is in the inoperative or retracted position. Sultable coagulating current is then caused to pass through the clamped area, preferably by connecting the patient with a suitable indiferent electrode, establishing an electrical connection between the indifferent electrode and one terminal of a source of coagulating current, and establishing an electrical connection between the other terminal of such current source and the binding post |0|.

After the desired degree of coagulation has been effected, similar electrical connections are made to conduct a cutting current to the cutting electrode |02. This will involve a connection between a source of cutting current and the binding post lil. The cutting electrode is then swung into its operative position, i. e., toward the fullline positions of Figures 6 and 8, whereby it will be caused to sweep transversely through the coagulated clamped area of the adhesion ||2, thereby cutting through the latter, as indicated in Figure 16. During this procedure, the coagulating connections will have been disconnected, or at least rendered inoperative.

These series of steps may be, as before, under complete and fully illuminated vision at all times; the fumes that are generated may be withdrawn in the same manner as hereinbefore described; and the cutting is effected without releasing the clamping jaws from engagement with the adhesion. As a` result, one of the stumps remains in engagement until after the cutting has been effected, as indicated in Figure 16, and this permits 75 the surgeon carefully to inspect and examine the same before finally releasing it.

We also contemplate providing the jaws, in either instrument herein described, with several teeth which are relatively long and in the nature .of pins `or the like, whereby the jaws may be partially separated without completely releasing the stump or stumps which they are engaging. This permits the surgeon to inspect the areas that have lain directly underneath the jaw surfaces, these areas being exposed by partial opening of the jaws, but the stumps being as yet unreleased by virtue of the longer teeth or pins which still project into them.

In Figures 17, 18, and 19, we have illustrated a few possible modifications in the mode of applyingthe coagulating current to the area to be coagulated. Referring back to Figure 11, for the moment, we will state that it frequently happens that the desired coagulation does not always take place with the desired degree of eicacy, at exactly the area engaged by the jaws, where the passage of current is effected by means of an indifferent electrode at a remote portion of the body. For example, if the adhesion is att-enuated at an unclamped remote area, coagulation m'ay take place at the attenuated area because of the concentration of current at such area and leave the clamped area insufciently coagulated. It is, therefore, obvious that under certain circumstances it may be desirable to dispense with the indifferent electrode and to pass the coagulating current to and through the desired areas by mfeans of a bi-polar association of parts and arrangement of electrical connections, whereby one of the jaws (e. g. the jaw 53) is connected to one terminal of the source of coagulating current, while the other jaw (e. g. jaw 55) is connected to the other terminal of such current source. With this mode of construction and electrical connection, the coagulating current will be caused to pass directly from one jaw to the other, and hence exactly through the areas which are to be coagulated. In a procedure of this character, the instrument employed will obviously have to have the two jaws 53 and 55 mutually insulated, with a provision for separate connections to each of these jaws, respectively. This possibility and mode of operation is illustrated in Figure 17 and is relevant to the present invention in so far as it illustrates a modified structural and electrical association of parts for carrying out the essential steps of our improved process.

A further possible modification is illustrated in Figure 18 in which two pairs of jaws similar to those illustrated in Figures 6-10 are provided. This would involve a modification of the instrument to duplicate the jaws 91 and 53, the jaws of one set being spaced from the jaws of another so that the adhesion is engaged at two spaced areas, as in Figure 11. Here, again, instead of having recourse to an indifferent electrode, it might be feasible to connect one pair of jaws to one terminal of a source of suitable coagulating current, and to connect the other pair of jaws to the other terminal of such source, whereby the coagulating current is caused to pass from one set of jaws to the other, and hence through the area which it is sought to coagulate.

In Figure 19, we have illustrated a further modication in which a single pair of jaws, as in Figures 6-10, 15, and 16 is adapted to be used in a bi-polar manner. One of the jaws is connected to one terminal of a source of coagulating current, and the other jaw to the other terminal 0f such source, whereby the current would pass directly from one jaw to the other and hence directly through the area to be coagulated. With such a procedure, the instrument of Figures 6-10 would have to be modified to mount the jaws in mutually insuiatcd relationship and to provide for separate electrical connections to the respective jaws.

The plus-and--minus signs appearing on Figures 17-19 are intended diagrammatically to illustrate the bi-polar modes of procedure hereinbefore referred to; and since these figures are diagrammatic, speciiic reference numerals have been omitted, the purpose and significance cf these figures being believed to be clear from the description and discussion hereinbefore contained.

The instrument of Figures 6-10 may in itself, without modification, be employed as a bi-polar instrument by bringing the electrode 92 into contact with the adhesion prior to the cutting operation, and by connecting the jaws 97-99 to one terminal of a source of coagulating current, and connecting the electrode H32 to the other terminal of such source. These connections are easily established at the binding posts lili and HG, respectively, and the coagulation current will be caused to pass directly through the area ultimately to be cut. With such a procedure, the coagulating operation is followed by establishing a connection at the binding post l |53 with a source of cutting current, and completing the latter circuit either by utilizing the jaws 9'1-99 as an indifferent electrode, or by relying upon the usual remote indifferent electrode.

Similarly, the device of Figures 1-5 may, without modification, be employed as a bi-polar instrument. The opposite terminals of a coagulating current may, for example, be connected, respectively, to the binding posts le and 7|, whereby such current will pass from the jaws 53-55 to the electrode 563, the latter having been brought into contact with the adhesion. This coagulating procedure would then be followed by making an electrical connection at the binding post 7| with one terminal of a source of cutting current, and employing either the jaws 53-55 as the indifferent electrode or relying upon the usual remote indifferent electrode.

These possible modifications in mode of electrically connecting the instrument and its associated parts are mentioned herein for the purpose of illustrating the possibility of carrying out our present method in a variety of ways, the essential characteristics of the method lying in the procedural steps of engaging the adhesion, coagulating it, cutting it, and not releasing it until after the cutting has been accomplished.

It will also be obvious that the swinging type of electrode as illustrated in Figures 6-10 at |02, may be adapted or employed, if desired, with a jaw arrangement of the character illustrated in Figures 1-5. By the same token, the axially reciprocable type of cutting electrode illustrated at 35 in Figures 1-5 may be adapted or employed, if desired, with a jaw construction and arrangement of the character illustrated in Figures 6-10.

While no mention has been made herein of any particular type of high-frequency current, other than by referring to the currents as cutting or coagulating currents, it is believed that the significance of these terms will be fully understood by those skilled in the art of electro-surgery as the same is practiced at the present day. However, it may be mentioned that a high-frequency generating apparatus of the general character illustrated in Letters Patent No. 1,962,796, is admirably suited for producing the two types of currents hereinbefore referred t0.

In general, it will be obvious that changes in the details, herein described and illustrated for the purpose of explaining the features of our invention, may be made by those skilled in the art Without departing from the spirit and scope of the invention as expressed in the appended claims. Y

It is, therefore, intended that these details be interpreted as illustrative, and not in a limiting sense. Y

Having thus described our invention, and illustrated its use, what we claim as new and desire to secure by Letters Patent is- 1. In the herein-described method of electrosurgically severing an adhesion, the steps which consist in firmly engaging the adhesion at two spaced areas on opposite sides of the area to be cut, electrically coagulating the area between the areas of engagement by means of a high-frequency coagulating current, and then electrically cutting transversely through said coagulated area by means of a high-frequency cutting current without releasing said engagement, whereby the lease thereof.

resultant stumps may be inspected before they are finally released.

2. In theherein-described method of electrosurgically severing an adhesion, the steps which consist in firmly engaging the adhesion adjacent to the area to be cut, electrically ccagulating said area by means of a high-frequency ccagulating current, and then electrically cutting transversely through said coagulated area by means of a high-frequency cutting current Without releasing said engagement, whereby at least one of the resultant stumps may be inspected before final reing a high-frequency cutting current through said body from one electrode to the otherand advancing the attenuated velectrode toward ythe other as the cutting action proceeds, and clamping said area on opposite sides of the plane of cutting, during the cutting procedure.

FREDERICK CHARLES WAPPLER. FREDERICK CHARLES WAPPLER,

Administrator olf Reinhold H. Wapinler, Deceased. 

